States Offer Case Studies For Federal Health Overhaul Efforts

Congress may end up looking toward Tennessee and Massachusetts for clues as to how federal reform will work as those states deal with costs associated with covering their own uninsured, The Associated Press reports.

And the two are an exercise in contrasts, while Massachusetts mandates that all its residents be insured and has enrolled 432,000 more uninsured in that state, Tennessee - with its optional coverage - has enrolled only 19,000 and covers only up to $10,000 of care per year.

"In Tennessee, that state's much smaller program hasn't cramped the budget, but few people are buying the new insurance even though premiums are as cheap as a monthly cell phone bill.

"A Massachusetts-style requirement for individuals to obtain health insurance is likely to emerge as part of the health overhaul taking shape in Congress, although details remain unsettled. A variation of Tennessee's practice of charging higher premiums to smokers and those who are overweight also may emerge; some in Congress are discussing a lifestyle tax on alcohol and sugar-sweetened drinks to help finance the national plan."

Tennessee's plan - called CoverTN - covers generic drugs, but some fear a medical crisis could bankrupt them, though officials say only eight have exceed the annual maximum in Tennessee, according to the AP. Officials also fear that the uninsured rate in Tennessee for working-age adults still hovers around 20 percent, though new Census data on the uninsured will be released later this year.

"What set the stage for Tennessee's go-slow approach was the state's history with expanding health insurance during the 1990s, said Gov. Phil Bredesen. A state program built around Medicaid, called TennCare, 'got totally out of control. It was growing at 15 percent a year. Tennessee had the most expensive Medicaid program in the country,' Bredesen said. 'Our experience with trying to do universal coverage ended up being a disaster.' When Bredesen took office in 2003, he inherited soaring state health care spending. In 2005, he cut 170,000 adults from TennCare. He reduced benefits for thousands more. 'This is not the insurance for someone who's going to get into a motorcycle accident,' Bredesen said" (Johnson, 5/28).

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